Conditions

MKSAP: 68-year-old woman with exertional leg discomfort

Conditions
July 26, 2014

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old woman is assessed for a 6-month history of progressive exertional leg discomfort, described as a “heaviness” involving both calves. The symptoms are relieved within 5 to 10 minutes of rest. She has noted the same limiting heaviness with bicycling. Medical history is significant for hypertension, type 2 diabetes mellitus, and …

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Dense breasts on mammogram? Don’t be afraid.

Conditions
July 10, 2014

Only in America can we find a way to scare the bejesus out of a woman with normal breasts and a normal mammogram. Because that’s exactly what happened when New York Times reporter Roni Caryn Rabin read her entirely normal mammogram results letter: “A sentence in the fourth paragraph grabbed me by the throat. ‘Your breast tissue is dense.'”

I can’t really blame Rabin for being afraid. The information about breast density in …

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How do we fix the high blood pressure problem?

Conditions
May 28, 2014

It’s a leading cause of death and disability in the U.S., leading to hundreds of thousands of preventable heart attacks, strokes and failed kidneys each year. About one-third of all American adults have it, according to the Centers for Disease Control, and it costs the nation about $50 billion annually to treat it and its complications.

“It” is high blood pressure, also known as hypertension. It is a symptomless, silent killer.

There are …

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Should BMI be used to measure obesity in children?

Conditions
April 25, 2014

Stephanie wrote in about a very common problem:

My daughter is 4 years old. She isn’t the tallest cat in town (she is about the 15th-25th percentile for height), and her BMI always ends up being in the high range (like over 85%). I worry about it. I am very health conscious for myself and my family. We live by all of the “rules.” And yet.

The family doctor doesn’t worry — …

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Sluggish cognitive tempo is a dangerous diagnostic idea

Conditions
April 23, 2014

Sluggish cognitive tempo may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

And I have seen some beauts during my forty years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by “experts” brim full with diagnostic exuberance — sometimes well meaning, sometimes influenced by extensive drug company affiliations — and always ungoverned by simple common sense, a respect for …

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Can one have a voice without vocal cords?

Conditions
April 20, 2014

I have a set of wind chimes hanging from an arbor that catch my attention whenever I am out in the garden and the breeze kicks up. They were given to me by Mrs. Mary Marlboro’s niece. Mary had purchased them while in hospice with instructions for her niece to give them to me after she passed on. I had cared for Mary for several years after I removed her …

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The choice between supportive and insight psychotherapy

Conditions
April 5, 2014

For more than a decade I’ve taught a seminar in dynamic psychotherapy to psychiatry residents. One tricky issue that arises every year is the apparent choice between conducting a “supportive” psychotherapy, versus an “analytic” or “insight-oriented” one. I developed a sailing analogy to clarify this issue, and to teach an important point about it.

Most patients appreciate emotionally comforting support. Many seek a therapist who will provide a listening ear, who …

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Weight loss resistance is real

Conditions
March 31, 2014

Weight is not a behavior, and weight is not a choice. Nobody wakes up and decides what to weigh today. In an age when healthy and unhealthy behaviors are increasingly subject to incentives and disincentives, respectively, this is all too easily forgotten.

Of course, weight is largely the byproduct of behaviors and choices, namely what and how much we eat, and what and how much we do: calories in and calories …

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Young patients with adenomas: Who should get genetic testing?

Conditions
March 20, 2014

While it is unusual for gastroenterologists to see colorectal tumors in patients under the age of 50, and even more uncommon before the age of 40, it does happen, so patients need to be aware of their risks. Colorectal tumors in young people are often detected either through symptom evaluation or because of a colonoscopy performed for an underlying risk factor, most commonly a family history of colorectal cancer (CRC).

During …

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Treating a symptom is not the same as treating a disease

Conditions
March 6, 2014

Physicians and patients collaborate to treat symptoms. This is not newsworthy and even sounds appropriate. Isn’t that what doctors are trained to do? It is but I’m not sure this should be a central focus of our healing mission. Treating a symptom is not the same as treating a disease.

For example, if an individual is having abdominal discomfort, pain medicine should not be the first responder, even if this would …

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What’s the difference between speech and voice?

Conditions
February 22, 2014

Mr. Heim Stillear, at 70-years-old, seems older and less intelligent to his family, since he was hospitalized for a stroke about two months ago. They come to the appointment with him and help him into the exam chair. When I ask Heim what is going on with him, the long pause before his strained answer begins makes his family uncomfortable.

His daughter interjects, “We are having a very difficult time understanding …

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Why doctors commit suicide

Conditions
February 18, 2014

PAMELA-WIBLE

I’ve been a doctor for twenty years. I’ve not lost a single patient to suicide.

I’ve lost only colleagues, friends, lovers — all male physicians — to suicide.

Why?

Here’s what I know:

A physician’s greatest joy is the patient relationship.

Assembly-line medicine undermines the patient-physician relationship.

Most doctors are burned out, overworked, or exhausted.

Many doctors spend little time with their families.

Workaholics are admired in medicine.

Medicine values …

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When patients abuse emergency department workers

Conditions
February 16, 2014

There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine.  Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.

A 2006 survey of emergency nurses showed that 25% …

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10 things to know about anesthesia and heart surgery

Conditions
February 15, 2014

american society of anesthesiologistsA guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

February is American Heart Month. Unfortunately, heart disease is a major problem in the United States that can result in surgery. In addition to discussing your procedure with your surgeon, you want to be sure to discuss your anesthesia care with your physician anesthesiologist.

Here are …

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5 truths about fevers in children

Conditions
February 10, 2014

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The flu, RSV, colds, croup, strep throat, ear infections. They all have one thing in common: they can cause fevers. And as any parent can attest to, it’s often the fever itself that freaks us out more than anything and prompts many parents to call their child’s pediatrician or hustle them off to the emergency room.

Fever is clearly not a parent’s …

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Treating post-viral coughs: This too shall pass

Conditions
February 1, 2014

‘Tis the season to be coughing …

It no longer takes an epidemiologist looking at absenteeism rates in schools to predict the start of influenza season.  For several years now there have been sophisticated models using search engine terms to monitor increasing incidence of febrile cough illness in regions of the world.

Or just ask a primary care clinic what its waiting room sounds like these days.   A chorus of coughs, high, low, dry, …

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Refusing the flu shot: Respecting the patient’s right to choose

Conditions
January 29, 2014

I’ve spent the past four weeks learning about primary care on my family medicine rotation. A significant portion of patient care in this setting is focused on health maintenance or disease prevention. Physicians can provide their patients with evidence-based recommendations for various screening tests and vaccinations, but it is ultimately up to the patient to decide what services he or she will receive.

According to the Centers for Disease Control and …

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Mohs surgery is vilified, physicians again fail to respond effectively

Conditions
January 29, 2014

An article published in the New York Times last weekend has been circulating widely on the Internet, and I feel that more than ever, physician voices are needed to reach the public and counter certain misconceptions put forth by the media.

The article, “Patients’ Costs Skyrocket; Specialists’ Incomes Soar,” charts the growth of specialist incomes in the past decade, using the case of a patient from Arkansas who had a …

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